The rising prevalence of autism spectrum disorder (ASD) has given pause to many epidemiologists and spawned aggressive attempts to search for an explanation. Whatever the underlying genomics of autism are, they cannot explain the increase because they have remained largely unchanged while the incidence has steadily risen. Hence it seems logical to think of environmental perturbations that have occurred concomitant with this rise that might plausibly be linked to it and would lend themselves to modification or remediation. Notably, the rise in ASD incidence began in earnest in 1996.1 What else began in the early 1990s? Infant television viewing. In 1970, the mean age at which children began to watch television was 4 years; by 2006 it was 4 months.2 Ecological associations are always fraught and problematic, but there are compelling theoretical reasons to believe that a potential causal linkage may exist between excessive early exposure to media and developmental outcomes in children, many of which are enumerated by Heffler et al3 in this issue of JAMA Pediatrics as motivating their study.

It is quite possible that if children at one-year of age who do not reciprocate caregiver engagement--that is. who do not laugh, make eye contact, etc.-- may be more likely to be placed in front of the television.

CONFLICT OF INTEREST:None Reported

April 28, 2020

Wouldn't It Be Wonderful?

Leonard Oestreicher, MD
| Society for Study of Autism and Social Communication

This study raises an interesting question.

What if there was something that parents could do during the first year of life to lower the risk of their children developing the traits of ASD? What if that something was as simple and rewarding as spending more social time with their infants while exposing them to less screen time?

There can be no serious argument anymore that the prevalence of ASD, no matter how it is defined, is dramatically increasing each year here in the United States and around the world. I would think that you would be hard pressed to find one practicing primary pediatrician in the country (the world?) who has not noticed this difference in their patient populations over the past twenty years. Likewise there can be no serious argument that screen time during the first year of life has not dramatically increased during this same period.

A correlation proves nothing is true. And if we are looking for proof of a casual relationship between these factors, we will not find them in this study. However the correlation ultimately is true or false whether we can scientifically demonstrate it or not. The authors have done their best but the data was never intended to answer this pressing question. It is important that we do much more research to find out where the actual truth lies. Meanwhile the correlation they found is tantalizing. The real question is if it is actionable. China has made their decision and clearly taken the lead in this matter, prohibiting any child under five years of age from watching screens for more than an hour a day.

Suppose we, who take care of families with infants, were to make a blanket recommendation that all such children avoid screen time and all caretakers use that time as much as possible to be face to face with their infants. If the correlation is really false, can we all agree that there is nothing lost.

If it is really true then wouldn't it be wonderful to discover that caretakers and the choices they make during the first year of life, during the time of peak brain plasticity, could actually make a positive difference to their infants and the social skills they ultimately develop? Would that be so surprising?